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Anyanwu C, Motamedi GK. Diagnosis and Surgical Treatment of Drug-Resistant Epilepsy. Brain Sci 2018; 8:E49. [PMID: 29561756 PMCID: PMC5924385 DOI: 10.3390/brainsci8040049] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 11/29/2022] Open
Abstract
Despite appropriate trials of at least two antiepileptic drugs, about a third of patients with epilepsy remain drug resistant (intractable; refractory). Epilepsy surgery offers a potential cure or significant improvement to those with focal onset drug-resistant seizures. Unfortunately, epilepsy surgery is still underutilized which might be in part because of the complexity of presurgical evaluation. This process includes classifying the seizure type, lateralizing and localizing the seizure onset focus (epileptogenic zone), confirming the safety of the prospective brain surgery in terms of potential neurocognitive deficits (language and memory functions), before devising a surgical plan. Each one of the above steps requires special tests. In this paper, we have reviewed the process of presurgical evaluation in patients with drug-resistant focal onset epilepsy.
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Affiliation(s)
- Chinekwu Anyanwu
- Department of Neurology, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA.
| | - Gholam K Motamedi
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20007, USA.
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Negwer C, Beurskens E, Sollmann N, Maurer S, Ille S, Giglhuber K, Kirschke JS, Ringel F, Meyer B, Krieg SM. Loss of Subcortical Language Pathways Correlates with Surgery-Related Aphasia in Patients with Brain Tumor: An Investigation via Repetitive Navigated Transcranial Magnetic Stimulation–Based Diffusion Tensor Imaging Fiber Tracking. World Neurosurg 2018; 111:e806-e818. [DOI: 10.1016/j.wneu.2017.12.163] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 11/26/2022]
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Scharfman HE, Kanner AM, Friedman A, Blümcke I, Crocker CE, Cendes F, Diaz-Arrastia R, Förstl H, Fenton AA, Grace AA, Palop J, Morrison J, Nehlig A, Prasad A, Wilcox KS, Jette N, Pohlmann-Eden B. Epilepsy as a Network Disorder (2): What can we learn from other network disorders such as dementia and schizophrenia, and what are the implications for translational research? Epilepsy Behav 2018; 78:302-312. [PMID: 29097123 PMCID: PMC5756681 DOI: 10.1016/j.yebeh.2017.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 12/18/2022]
Abstract
There is common agreement that many disorders of the central nervous system are 'complex', that is, there are many potential factors that influence the development of the disease, underlying mechanisms, and successful treatment. Most of these disorders, unfortunately, have no cure at the present time, and therapeutic strategies often have debilitating side effects. Interestingly, some of the 'complexities' of one disorder are found in another, and the similarities are often network defects. It seems likely that more discussions of these commonalities could advance our understanding and, therefore, have clinical implications or translational impact. With this in mind, the Fourth International Halifax Epilepsy Conference and Retreat was held as described in the prior paper, and this companion paper focuses on the second half of the meeting. Leaders in various subspecialties of epilepsy research were asked to address aging and dementia or psychosis in people with epilepsy (PWE). Commonalities between autism, depression, aging and dementia, psychosis, and epilepsy were the focus of the presentations and discussion. In the last session, additional experts commented on new conceptualization of translational epilepsy research efforts. Here, the presentations are reviewed, and salient points are highlighted.
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Affiliation(s)
- Helen E Scharfman
- Departments of Psychiatry, Neurosciences and Physiology, and the Neuroscience Institute, New York University Langone Medical Center, New York, NY 10016, USA.
| | - Andres M Kanner
- University of Miami, Miller School of Medicine, 1120 NW 14th Street, Room #1324, Miami, FL 33136, USA
| | - Alon Friedman
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ingmar Blümcke
- Neuropathological Institute, University Hospitals Erlangen, Germany
| | - Candice E Crocker
- Nova Scotia Early Psychosis Program, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Fernando Cendes
- Department of Neurology, University of Campinas, 13083-888 Campinas, Sao Paulo, Brazil
| | - Ramon Diaz-Arrastia
- Centre for Neuroscience & Regenerative Medicine, Uniformed Services University of the Health Sciences, 12725 Twinbrook Parkway, Rockville, MD 20852, USA
| | - Hans Förstl
- Department of Psychiatry, University of Munich, Klinikum rechts der Isar, Ismaninger Strabe 22, D-81675 Munich, Germany
| | - André A Fenton
- Centre for Neural Science, New York University, 4 Washington Place, Room 809, New York, NY 10003, USA
| | - Anthony A Grace
- University of Pittsburgh, 456 Langley Hall, 4200 Fifth Avenue, Pittsburgh, PA 15269, USA
| | - Jorge Palop
- Department of Neurology, Gladstone Institute, 1650 Owens Street, San Francisco, CA 94158-2261, USA
| | - Jason Morrison
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Astrid Nehlig
- INSERM U 1129, Hôpital Necker, Paris, Faculty of Medicine, Strasbourg, France
| | - Asuri Prasad
- Department of Pediatrics, Children's Hospital of Western Ontario, London, ON, Canada
| | - Karen S Wilcox
- Department of Pharmacology & Toxicology, Anticonvulsant Drug Development Program, University of Utah, Salt Lake City, UT, USA
| | - Nathalie Jette
- Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, NY, USA; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Bernd Pohlmann-Eden
- Brain Repair Center, Life Science Research Institute, Dalhousie University, Room 229, PO Box 15000, Halifax, NS B3H4R2, Canada.
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Silva MA, See AP, Essayed WI, Golby AJ, Tie Y. Challenges and techniques for presurgical brain mapping with functional MRI. NEUROIMAGE-CLINICAL 2017; 17:794-803. [PMID: 29270359 PMCID: PMC5735325 DOI: 10.1016/j.nicl.2017.12.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/10/2017] [Accepted: 12/05/2017] [Indexed: 01/22/2023]
Abstract
Functional magnetic resonance imaging (fMRI) is increasingly used for preoperative counseling and planning, and intraoperative guidance for tumor resection in the eloquent cortex. Although there have been improvements in image resolution and artifact correction, there are still limitations of this modality. In this review, we discuss clinical fMRI's applications, limitations and potential solutions. These limitations depend on the following parameters: foundations of fMRI, physiologic effects of the disease, distinctions between clinical and research fMRI, and the design of the fMRI study. We also compare fMRI to other brain mapping modalities which should be considered as alternatives or adjuncts when appropriate, and discuss intraoperative use and validation of fMRI. These concepts direct the clinical application of fMRI in neurosurgical patients. fMRI is increasingly used for presurgical brain mapping for surgical planning. Understanding of the limitations of fMRI is critical for its clinical use. Clinical fMRI's challenges and potential solutions are discussed. Intraoperative use and validation of fMRI are discussed.
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Affiliation(s)
- Michael A Silva
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Alfred P See
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Walid I Essayed
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Alexandra J Golby
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Yanmei Tie
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA.
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Ghinda DC, Wu JS, Duncan NW, Northoff G. How much is enough-Can resting state fMRI provide a demarcation for neurosurgical resection in glioma? Neurosci Biobehav Rev 2017; 84:245-261. [PMID: 29198588 DOI: 10.1016/j.neubiorev.2017.11.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 01/09/2023]
Abstract
This study represents a systematic review of the insights provided by resting state functional MRI (rs-fMRI) use in the glioma population. Following PRISMA guidelines, 45 studies were included in the review and were classified in glioma-related neuronal changes (n=28) and eloquent area localization (n=17). Despite the heterogeneous nature of the studies, there is considerable evidence of diffuse functional reorganization occurring in the setting of gliomas with local and interhemispheric functional connectivity alterations involving different functional networks. The studies showed evidence of decreased long distance functional connectivity and increased global local efficiency occurring in the setting of gliomas. The tumour grade seems to correlate with distinct functional connectivity changes. Overall, there is a potential clinical utility of rs-fMRI for identifying the functional brain network disruptions occurring in the setting of gliomas. Further studies utilizing standardized analytical methods are required to elucidate the mechanism through which gliomas induce global changes in brain connectivity.
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Affiliation(s)
- Diana C Ghinda
- Ottawa Hospital Research Institute, University of Ottawa, Division of Neurosurgery, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada; Mind, Brain Imaging and Neuroethics, Canada Research Chair, EJLB-Michael Smith Chair for Neuroscience and Mental Health, Royal Ottawa Mental Health Centre, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K4, Canada.
| | - Jin-Song Wu
- Glioma Surgery Division, Department of Neurological Surgery, Huashan Hospital, Fudan University, 518 Wuzhong E Rd, Shanghai, China.
| | - Niall W Duncan
- Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, 250 Wu-Xing Street, Taipei, 11031, Taiwan.
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics, Canada Research Chair, EJLB-Michael Smith Chair for Neuroscience and Mental Health, Royal Ottawa Mental Health Centre, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K4, Canada; Mental Health Center/7th Hospital, Zhejiang University School of Medicine, 305 Tianmu Road, Hangzhou, Zhejiang Province, 310013, China.
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Połczyńska M, Kuhn T, You SC, Walshaw P, Curtiss S, Bookheimer S. Assessment of grammar optimizes language tasks for the intracarotid amobarbital procedure. Epilepsy Behav 2017; 76:89-100. [PMID: 28923498 DOI: 10.1016/j.yebeh.2017.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/24/2017] [Accepted: 08/14/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE A previous study showed that assessment of language laterality could be improved by adding grammar tests to the recovery phase of the intracarotid amobarbital procedure (IAP) (Połczyńska et al. 2014). The aim of this study was to further investigate the extent to which grammar tests lateralize language function during the recovery phase of the IAP in a larger patient sample. METHODS Forty patients with drug-resistant epilepsy (14 females, thirty-two right-handed, mean age 38.5years, SD=10.6) participated in this study. On EEG, 24 patients had seizures originating in the left hemisphere (LH), 13 in the right hemisphere (RH), and 4 demonstrated mixed seizure origin. Thirty participants (75%) had bilateral injections, and ten (25%) had unilateral injections (five RH and five LH). Based on results from the encoding phase, we segregated our study participants to a LH language dominant and a mixed dominance group. In the recovery phase of the IAP, the participants were administered a new grammar test (the CYCLE-N) and a standard language test. We analyzed the laterality index measure and effect sizes in the two tests. KEY FINDINGS In the LH-dominant group, the CYCLE-N generated more profound language deficits in the recovery phase than the standard after injection to either hemisphere (p<0.001). At the same time, the laterality index for the grammar tasks was still higher than for the standard tests. Critically, the CYCLE-N administered in the recovery phase was nearly as effective as the standard tests given during the encoding phase. SIGNIFICANCE The results may be significant for individuals with epilepsy undergoing IAP. The grammar tests may be a highly efficient measure for lateralizing language function in the recovery phase.
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Affiliation(s)
- Monika Połczyńska
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA; Faculty of English, Adam Mickiewicz University, Poznań, Poland.
| | - Taylor Kuhn
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA.
| | - S Christine You
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA.
| | - Patricia Walshaw
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA.
| | | | - Susan Bookheimer
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA.
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Zago L, Hervé PY, Genuer R, Laurent A, Mazoyer B, Tzourio-Mazoyer N, Joliot M. Predicting hemispheric dominance for language production in healthy individuals using support vector machine. Hum Brain Mapp 2017; 38:5871-5889. [PMID: 28868791 DOI: 10.1002/hbm.23770] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 07/27/2017] [Accepted: 08/08/2017] [Indexed: 01/16/2023] Open
Abstract
We used a Support Vector Machine (SVM) classifier to assess hemispheric pattern of language dominance of 47 individuals categorized as non-typical for language from their hemispheric functional laterality index (HFLI) measured on a sentence minus word-list production fMRI-BOLD contrast map. The SVM classifier was trained at discriminating between Dominant and Non-Dominant hemispheric language production activation pattern on a group of 250 participants previously identified as Typicals (HFLI strongly leftward). Then, SVM was applied to each hemispheric language activation pattern of 47 non-typical individuals. The results showed that at least one hemisphere (left or right) was found to be Dominant in every, except 3 individuals, indicating that the "dominant" type of functional organization is the most frequent in non-typicals. Specifically, left hemisphere dominance was predicted in all non-typical right-handers (RH) and in 57.4% of non-typical left-handers (LH). When both hemisphere classifications were jointly considered, four types of brain patterns were observed. The most often predicted pattern (51%) was left-dominant (Dominant left-hemisphere and Non-Dominant right-hemisphere), followed by right-dominant (23%, Dominant right-hemisphere and Non-Dominant left-hemisphere) and co-dominant (19%, 2 Dominant hemispheres) patterns. Co-non-dominant was rare (6%, 2 Non-Dominant hemispheres), but was normal variants of hemispheric specialization. In RH, only left-dominant (72%) and co-dominant patterns were detected, while for LH, all types were found, although with different occurrences. Among the 10 LH with a strong rightward HFLI, 8 had a right-dominant brain pattern. Whole-brain analysis of the right-dominant pattern group confirmed that it exhibited a functional organization strictly mirroring that of left-dominant pattern group. Hum Brain Mapp 38:5871-5889, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Laure Zago
- Université de Bordeaux, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France.,CNRS, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France.,CEA, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France
| | - Pierre-Yves Hervé
- Université de Bordeaux, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France.,CNRS, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France.,CEA, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France
| | - Robin Genuer
- Université de Bordeaux, ISPED, Centre INSERM U-1219, F-33000 Bordeaux, France.,INSERM, ISPED, Centre INSERM U-1219, F-33000 Bordeaux, France
| | - Alexandre Laurent
- Université de Bordeaux, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France.,CNRS, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France.,CEA, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France
| | - Bernard Mazoyer
- Université de Bordeaux, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France.,CNRS, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France.,CEA, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France
| | - Nathalie Tzourio-Mazoyer
- Université de Bordeaux, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France.,CNRS, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France.,CEA, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France
| | - Marc Joliot
- Université de Bordeaux, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France.,CNRS, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France.,CEA, Institut des Maladies Neurodégéneratives, UMR 5293, Groupe d'Imagerie Neurofonctionnelle, F-33000 Bordeaux, France
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Patrikelis P, Lucci G, Siatouni A, Verentzioti A, Alexoudi A, Gatzonis S. Potential implications of Luria's work for the neuropsychology of epilepsy and epilepsy surgery: A perspective for re-examination. Epilepsy Behav 2017; 72:161-172. [PMID: 28605690 DOI: 10.1016/j.yebeh.2017.04.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/24/2017] [Accepted: 04/25/2017] [Indexed: 11/26/2022]
Abstract
The pioneeristic work of Alexander Romanovic Luria into the field of human neuropsychology offered eminent contributions to clinical praxis by providing theory guided methods and instruments for the study of higher cortical functions. However, lots of this knowledge corpus either remains untranslated and thus inaccessible, or in some cases selectively overlooked by academic authorities and consequently not passed to the future generations of experts. Although Luria was not exclusively devoted to the study of epilepsy, his theories and clinical approaches actually penetrate the whole neuropathology spectrum. His holistic and systemic approach to the brain sounds nowadays more than opportune and consistent with the network approach of the modern neuroimaging era. As to epilepsy, the logic underlying the Lurian approach (cognitive functions organized into complex functional systems with intra- and/or inter-hemispheric distribution, as opposed to the modularistic view of the brain) seems consistent with our current knowledge in epileptology with respect to epileptic networks, as well as the modern construct of the functional deficit zone. These contributions seem to be highly promising for the neuropsychology of epilepsy and epilepsy surgery, since they provide clinicians with valuable methods and theories to assist them in the localization -and lateralization- of cognitive deficits. Consequently they are of great applicability in the context of the preoperative neuropsychological monitoring of patients candidates for epilepsy surgery, where neuropsychologist are called upon to provide surgeons with anatomical data.
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Affiliation(s)
- Panayiotis Patrikelis
- Epilepsy Surgery Unit, Department of Neurosurgery, School of Medicine, Evangelismos Hospital, University of Athens, Greece.
| | | | - Anna Siatouni
- Epilepsy Surgery Unit, Department of Neurosurgery, School of Medicine, Evangelismos Hospital, University of Athens, Greece
| | - Anastasia Verentzioti
- Epilepsy Surgery Unit, Department of Neurosurgery, School of Medicine, Evangelismos Hospital, University of Athens, Greece
| | - Athanasia Alexoudi
- Epilepsy Surgery Unit, Department of Neurosurgery, School of Medicine, Evangelismos Hospital, University of Athens, Greece
| | - Stylianos Gatzonis
- Epilepsy Surgery Unit, Department of Neurosurgery, School of Medicine, Evangelismos Hospital, University of Athens, Greece
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Połczyńska MM, Japardi K, Bookheimer SY. Lateralizing language function with pre-operative functional magnetic resonance imaging in early proficient bilingual patients. BRAIN AND LANGUAGE 2017; 170:1-11. [PMID: 28343082 DOI: 10.1016/j.bandl.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 10/17/2016] [Accepted: 03/15/2017] [Indexed: 06/06/2023]
Abstract
Research on bilinguals with brain lesions is complicated by high patient variability, making it difficult to find well-matched controls. We benefitted from a database of over 700 patients and conducted an analysis of pre-operative functional magnetic resonance imaging data to assess language dominance in 25 early, highly proficient Spanish-English bilinguals, and 25 carefully matched monolingual controls. Our results showed that early bilingualism is associated with greater bilateral hemispheric involvement, and monolingualism is associated with stronger left hemisphere lateralization (p=0.009). The bilinguals showed more pronounced right hemisphere activation (p=0.008). Although language dominance values were concordant in the bilingual group, there were a few (12%) atypical cases with different lateralization patterns in L1 and L2. Finally, we found distinct areas of activity in first and second language within the language network, in addition to regions of convergence. These data underscore the need to map all languages proficiently spoken by surgical candidates.
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Affiliation(s)
- Monika M Połczyńska
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA; Faculty of English, Adam Mickiewicz University, Poznań, Poland.
| | - Kevin Japardi
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
| | - Susan Y Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
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Benjamin CF, Walshaw PD, Hale K, Gaillard WD, Baxter LC, Berl MM, Polczynska M, Noble S, Alkawadri R, Hirsch LJ, Constable RT, Bookheimer SY. Presurgical language fMRI: Mapping of six critical regions. Hum Brain Mapp 2017; 38:4239-4255. [PMID: 28544168 PMCID: PMC5518223 DOI: 10.1002/hbm.23661] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 02/01/2023] Open
Abstract
Language mapping is a key goal in neurosurgical planning. fMRI mapping typically proceeds with a focus on Broca's and Wernicke's areas, although multiple other language‐critical areas are now well‐known. We evaluated whether clinicians could use a novel approach, including clinician‐driven individualized thresholding, to reliably identify six language regions, including Broca's Area, Wernicke's Area (inferior, superior), Exner's Area, Supplementary Speech Area, Angular Gyrus, and Basal Temporal Language Area. We studied 22 epilepsy and tumor patients who received Wada and fMRI (age 36.4[12.5]; Wada language left/right/mixed in 18/3/1). fMRI tasks (two × three tasks) were analyzed by two clinical neuropsychologists who flexibly thresholded and combined these to identify the six regions. The resulting maps were compared to fixed threshold maps. Clinicians generated maps that overlapped significantly, and were highly consistent, when at least one task came from the same set. Cases diverged when clinicians prioritized different language regions or addressed noise differently. Language laterality closely mirrored Wada data (85% accuracy). Activation consistent with all six language regions was consistently identified. In blind review, three external, independent clinicians rated the individualized fMRI language maps as superior to fixed threshold maps; identified the majority of regions significantly more frequently; and judged language laterality to mirror Wada lateralization more often. These data provide initial validation of a novel, clinician‐based approach to localizing language cortex. They also demonstrate clinical fMRI is superior when analyzed by an experienced clinician and that when fMRI data is of low quality judgments of laterality are unreliable and should be withheld. Hum Brain Mapp 38:4239–4255, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Christopher F Benjamin
- Department of Neurology, Comprehensive Epilepsy Center, Yale School of Medicine, New Haven, Connecticut.,Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Patricia D Walshaw
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California
| | - Kayleigh Hale
- U.S. Department of Veterans Affairs, War Related Illness and Injury Study Center, Washington, DC
| | - William D Gaillard
- Center for Neuroscience Research, Children's National Health System, Washington, DC
| | - Leslie C Baxter
- Department of Neuroimaging Research, Barrow Neurological Institute, Phoenix, Arizona
| | - Madison M Berl
- Center for Neuroscience Research, Children's National Health System, Washington, DC
| | - Monika Polczynska
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California.,Faculty of English, Adam Mickiewicz University, Poznań, Poland
| | - Stephanie Noble
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Rafeed Alkawadri
- Department of Neurology, Comprehensive Epilepsy Center, Yale School of Medicine, New Haven, Connecticut
| | - Lawrence J Hirsch
- Department of Neurology, Comprehensive Epilepsy Center, Yale School of Medicine, New Haven, Connecticut
| | - R Todd Constable
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Susan Y Bookheimer
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California
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Austermuehle A, Cocjin J, Reynolds R, Agrawal S, Sepeta L, Gaillard WD, Zaghloul K, Inati S, Theodore WH. Language functional MRI and direct cortical stimulation in epilepsy preoperative planning. Ann Neurol 2017; 81:526-537. [PMID: 28220524 PMCID: PMC5401636 DOI: 10.1002/ana.24899] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Presurgical language assessment can help minimize damage to eloquent cortex during resective epilepsy surgery. Two methods for presurgical language mapping are functional MRI (fMRI) and direct cortical stimulation (DCS) of implanted subdural electrodes. We compared fMRI results to DCS to help optimize noninvasive language localization and assess its validity. METHODS We studied 19 patients referred for presurgical evaluation of drug-resistant epilepsy. Patients completed four language tasks during preoperative fMRI. After subdural electrode implantation, we used DCS to localize language areas. For each stimulation site, we determined whether language positive electrode pairs intersected with significant fMRI activity clusters for language tasks. RESULTS Sensitivity and specificity depended on electrode region of interest radii and statistical thresholding. For patients with at least one language positive stimulation site, an auditory description decision task provided the best trade-off between sensitivity and specificity. For patients with no language positive stimulation sites, fMRI was a dependable method of excluding eloquent language processing. INTERPRETATION Language fMRI is an effective tool for determining language lateralization before electrode implantation and is especially useful for excluding unexpected critical language areas. It can help guide subdural electrode implantation and narrow the search for eloquent cortical areas by DCS. Ann Neurol 2017;81:526-537.
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Affiliation(s)
- Alison Austermuehle
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke
| | - John Cocjin
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke
| | - Richard Reynolds
- Scientific and Statistical Computing Core, National Institute of Mental Health
| | - Shubhi Agrawal
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke
| | - Leigh Sepeta
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke
| | - William D. Gaillard
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke
| | - Kareem Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke
| | - Sara Inati
- Electroencephalography Section, National Institute of Neurological Disorders and Stroke
| | - William H. Theodore
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke
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64
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Pseudoneglect in line bisection judgement is associated with a modulation of right hemispheric spatial attention dominance in right-handers. Neuropsychologia 2017; 94:75-83. [DOI: 10.1016/j.neuropsychologia.2016.11.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 02/05/2023]
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65
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Multi-factorial modulation of hemispheric specialization and plasticity for language in healthy and pathological conditions: A review. Cortex 2017; 86:314-339. [DOI: 10.1016/j.cortex.2016.05.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/16/2016] [Accepted: 05/13/2016] [Indexed: 12/16/2022]
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66
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Cognitive Functioning in Temporal Lobe Epilepsy: A BOLD-fMRI Study. Mol Neurobiol 2016; 54:8361-8369. [DOI: 10.1007/s12035-016-0298-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
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67
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Sollmann N, Hauck T, Tussis L, Ille S, Maurer S, Boeckh-Behrens T, Ringel F, Meyer B, Krieg SM. Results on the spatial resolution of repetitive transcranial magnetic stimulation for cortical language mapping during object naming in healthy subjects. BMC Neurosci 2016; 17:67. [PMID: 27776478 PMCID: PMC5078936 DOI: 10.1186/s12868-016-0305-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/19/2016] [Indexed: 11/20/2022] Open
Abstract
Background The spatial resolution of repetitive navigated transcranial magnetic stimulation (rTMS) for language mapping is largely unknown. Thus, to determine a minimum spatial resolution of rTMS for language mapping, we evaluated the mapping sessions derived from 19 healthy volunteers for cortical hotspots of no-response errors. Then, the distances between hotspots (stimulation points with a high error rate) and adjacent mapping points (stimulation points with low error rates) were evaluated. Results Mean distance values of 13.8 ± 6.4 mm (from hotspots to ventral points, range 0.7–30.7 mm), 10.8 ± 4.8 mm (from hotspots to dorsal points, range 2.0–26.5 mm), 16.6 ± 4.8 mm (from hotspots to apical points, range 0.9–27.5 mm), and 13.8 ± 4.3 mm (from hotspots to caudal points, range 2.0–24.2 mm) were measured. Conclusions According to the results, the minimum spatial resolution of rTMS should principally allow for the identification of a particular gyrus, and according to the literature, it is in good accordance with the spatial resolution of direct cortical stimulation (DCS). Since measurement was performed between hotspots and adjacent mapping points and not on a finer-grained basis, we only refer to a minimum spatial resolution. Furthermore, refinement of our results within the scope of a prospective study combining rTMS and DCS for resolution measurement during language mapping should be the next step.
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Affiliation(s)
- Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Theresa Hauck
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lorena Tussis
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stefanie Maurer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tobias Boeckh-Behrens
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
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68
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O'Grady C, Omisade A, Sadler RM. Language lateralization of a bilingual person with epilepsy using a combination of fMRI and neuropsychological assessment findings. Neurocase 2016; 22:436-442. [PMID: 27653991 DOI: 10.1080/13554794.2016.1233987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This report describes the findings of language functional magnetic resonance imaging (fMRI) in a left-handed Urdu and English speaker with right hemisphere-originating epilepsy and unclear language dominance. fMRI is a reliable method for determining hemispheric language dominance in presurgical planning. However, the effects of bilingualism on language activation depend on many factors including age of acquisition and proficiency in the tested language, and morphological properties of the language itself. This case demonstrates that completing fMRI in both spoken languages and interpreting the results within the context of a neuropsychological assessment are essential in arriving at accurate conclusions about language distribution in bilingual patients.
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Affiliation(s)
| | - Antonina Omisade
- b Acquired Brain Injury - Surgical Epilepsy Programme , Nova Scotia Health Authority , Halifax , Canada
| | - R Mark Sadler
- c Division of Neurology , Dalhousie University , Halifax , Canada
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69
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Determination of hemispheric language dominance using functional magnetic resonance imaging and the Shiritori (Japanese word chain) task in patients with epilepsy: Comparison with the Wada test. Epilepsy Res 2016; 124:16-22. [DOI: 10.1016/j.eplepsyres.2016.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 12/04/2015] [Accepted: 04/21/2016] [Indexed: 11/20/2022]
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70
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Negwer C, Sollmann N, Ille S, Hauck T, Maurer S, Kirschke JS, Ringel F, Meyer B, Krieg SM. Language pathway tracking: comparing nTMS-based DTI fiber tracking with a cubic ROIs-based protocol. J Neurosurg 2016; 126:1006-1014. [PMID: 27231977 DOI: 10.3171/2016.2.jns152382] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Diffusion tensor imaging (DTI) fiber tracking (FT) has been widely used in glioma surgery in recent years. It can provide helpful information about subcortical structures, especially in patients with eloquent space-occupying lesions. This study compared the newly developed navigated transcranial magnetic stimulation (nTMS)-based DTI FT of language pathways with the most reproducible protocol for language pathway tractography, using cubic regions of interest (ROIs) for the arcuate fascicle. METHODS Thirty-seven patients with left-sided perisylvian lesions underwent language mapping by repetitive nTMS. DTI FT was performed using the cubic ROIs-based protocol and the authors' nTMS-based DTI FT approach. The same minimal fiber length and fractional anisotropy were chosen (50 mm and 0.2, respectively). Both protocols were performed with standard clinical tractography software. RESULTS Both methods visualized language-related fiber tracts (i.e., corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, and frontooccipital fascicle) in all 37 patients. Using the cubic ROIs-based protocol, 39.9% of these language-related fiber tracts were detected in the examined patients, as opposed to 76.0% when performing nTMS-based DTI FT. For specifically tracking the arcuate fascicle, however, the cubic ROIs-based approach showed better results (97.3% vs 75.7% with nTMS-based DTI FT). CONCLUSIONS The cubic ROIs-based protocol was designed for arcuate fascicle tractography, and this study shows that it is still useful for this intention. However, superior results were obtained using the nTMS-based DTI FT for visualization of other language-related fiber tracts.
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Affiliation(s)
- Chiara Negwer
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Nico Sollmann
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Sebastian Ille
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | - Theresa Hauck
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
| | | | - Jan S Kirschke
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | | | | | - Sandro M Krieg
- Department of Neurosurgery.,TUM-Neuroimaging Center, and
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71
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Połczyńska MM, Benjamin CFA, Japardi K, Frew A, Bookheimer SY. Language system organization in a quadrilingual with a brain tumor: Implications for understanding of the language network. Neuropsychologia 2016; 86:167-75. [PMID: 27143224 DOI: 10.1016/j.neuropsychologia.2016.04.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/03/2016] [Accepted: 04/29/2016] [Indexed: 11/26/2022]
Abstract
In pre-neurosurgery language mapping it is critical to identify language-specific regions in multilingual speakers. We conducted pre-operative functional magnetic resonance imaging, and intraoperative language mapping in the unique case of a highly proficient quadrilingual with a left frontal brain tumor who acquired her second language at age 5, and her third and fourth languages at 15. We found a predominantly different organization in each language with only a few areas shared by all 4 languages. Contrary to existing evidence, impairment across languages was not related to age of acquisition, amount of exposure, or language similarity. This case suggests that the functional structure of the language system may be highly idiosyncratic in multilingual individuals and supports detailed study in this group to inform neurocognitive models of language.
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Affiliation(s)
- Monika M Połczyńska
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA 90024, USA; Faculty of English, Adam Mickiewicz University, Poznań, Poland.
| | - Christopher F A Benjamin
- Division of Neuropsychology, Depts. of Neurology & Neurosurgery, Yale University, 800 Howard Ave, New Haven, CT 06511, USA.
| | - Kevin Japardi
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA 90024, USA.
| | - Andrew Frew
- Department of Neurology, Department of Neurosurgery David Geffen School of Medicine, University of California, Los Angeles, Ahmanson-Lovelace Brain Mapping Center Room 163, 660 Charles E. Young Drive South, Los Angeles, CA 90095-7085, USA.
| | - Susan Y Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA 90024, USA.
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72
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Martinez-Rios C, McAndrews MP, Logan W, Krings T, Lee D, Widjaja E. MRI in the evaluation of localization-related epilepsy. J Magn Reson Imaging 2016; 44:12-22. [PMID: 27115073 DOI: 10.1002/jmri.25269] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/28/2016] [Indexed: 11/06/2022] Open
Abstract
This article covers the MRI evaluation of patients with epilepsy, with a focus on neuroimaging in those with localization-related epilepsy who may be potential epilepsy surgery candidates. The article includes structural MRI to identify a lesion, functional MRI to identify the eloquent cortex and diffusion tensor imaging to identify the eloquent white matter tracts. We consider the equipment, protocol or procedures, and reporting of MRI in patients with epilepsy. Recommendations for both adult and pediatric patients are described for protocols and procedures. The authors hope that this article will provide a standardized approach for clinical imaging of patients with suspected localization-related epilepsy who may be evaluated for epilepsy surgery. J. Magn. Reson. Imaging 2016.
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Affiliation(s)
| | | | - William Logan
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timo Krings
- University Health Network, Toronto, Ontario, Canada
| | - Donald Lee
- London Health Sciences Center, London, Ontario, Canada
| | - Elysa Widjaja
- Department of Radiology, Hospital for Sick Children, Toronto, Ontario, Canada
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73
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Usami K, Kubota M, Kawai K, Kunii N, Matsuo T, Ibayashi K, Takahashi M, Kamada K, Momose T, Aoki S, Saito N. Long-term outcome and neuroradiologic changes after multiple hippocampal transection combined with multiple subpial transection or lesionectomy for temporal lobe epilepsy. Epilepsia 2016; 57:931-40. [PMID: 27080062 DOI: 10.1111/epi.13374] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Multiple hippocampal transection (MHT) is a surgical procedure developed to avoid postoperative memory decline. Its efficacy has been documented in only a few small series with relatively short observation periods. We prospectively evaluated the long-term seizure and cognitive outcomes of MHT combined with multiple subpial transection or lesionectomy (MHT + MST/L). Moreover, we quantitatively evaluated the structural and metabolic neuroradiologic changes after the procedure to elucidate the anatomofunctional correlates of memory preservation. METHODS Twenty-four patients underwent MHT + MST/L for treatment of drug-resistant mesial temporal lobe epilepsy (mTLE) and were followed for more than 5 years. Indications for the procedure were the following: (1) verbally dominant-sided surgery in patients with a radiologically normal hippocampus or normal/near normal memory, and (2) surgery for patients with concomitant epileptic activity on the contralateral side, that is, when the surgery was considered a high risk for severe postoperative memory decline. Seizure outcome was evaluated using Engel's classification 1, 2, and 3 years after surgery, and at the last visit (LV). Three subgroups were evaluated as well: magnetic resonance imaging (MRI) negative (MN), hippocampal sclerosis (HS), and normal hippocampus with extrahippocampal lesion (NHEL). The long-term cognitive outcome was followed through to LV in patients who underwent verbally dominant-sided surgery. Hippocampal volume (HV), diffusion tensor parameters (DTP), and glucose utilization (GU) were determined from MRI and fluorodeoxyglucose-positron emission tomography (FDG-PET) studies performed before and >6 months after surgery. RESULTS Whereas the rate of Engel class I as a whole was 71% at 1 year and 67% at LV, the rates in the MN, HS, and NHEL groups were 60%, 67%, and 100% at 1 year, respectively, and 70%, 56%, and 80% at LV, respectively. Memory indices after verbally dominant-sided surgery transiently declined at 1 month but recovered to and remained at the preoperative level through LV. The HV, DTP of the fornix, and GU of the temporal lobe on the treated side showed pathologic changes even when the transiently declined memory indices had recovered to the preoperative level. SIGNIFICANCE The long-term outcome for complex partial seizures after MHT + MST/L was comparable to that seen after anterior temporal lobectomy. The long-term cognitive outcome was favorable, even for patients with a high risk of severe postoperative memory decline. MHT + MST/L may be a treatment option for mTLE in which resective surgery carries a risk of postoperative memory decline, particularly in patients without MRI lesion. A discrepancy between the preserved memory and the pathologic neuroradiologic changes indicates the necessity for further studies including functional MRI.
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Affiliation(s)
- Kenichi Usami
- Department of Neurosurgery and Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Mayumi Kubota
- Department of Neurosurgery and Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kensuke Kawai
- Department of Neurosurgery and Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Naoto Kunii
- Department of Neurosurgery and Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Matsuo
- Department of Neurosurgery and Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kenji Ibayashi
- Department of Neurosurgery and Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Miwako Takahashi
- Department of Neurosurgery and Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kyousuke Kamada
- Department of Neurosurgery and Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Toshimitsu Momose
- Department of Neurosurgery and Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Neurosurgery and Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery and Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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74
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Sollmann N, Negwer C, Ille S, Maurer S, Hauck T, Kirschke JS, Ringel F, Meyer B, Krieg SM. Feasibility of nTMS-based DTI fiber tracking of language pathways in neurosurgical patients using a fractional anisotropy threshold. J Neurosci Methods 2016; 267:45-54. [PMID: 27059128 DOI: 10.1016/j.jneumeth.2016.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Navigated transcranial magnetic stimulation (nTMS) provides language maps in brain tumor patients. Yet, corresponding data on the visualization of language-related subcortical pathways is lacking. Therefore, this study evaluates the feasibility of nTMS-based diffusion tensor imaging fiber tracking (DTI FT) for subcortical language pathways by a fractional anisotropy (FA) protocol. NEW METHOD DTI FT was performed in 37 patients suffering from left-sided perisylvian brain lesions based on nTMS data exclusively, using the FA-based protocol originally established for the corticospinal tract (CST) by Frey et al. (2012): minimum fiber length was 110mm and the highest individual FA value leading to visualization of white matter tracts was determined as the FA threshold (FAT). Then, deterministic DTI FT using an FA value of 100%, 75%, 50%, and 25% of the individual FAT (with 25% as an additional setting to the original protocol) was performed. RESULTS Our approach visualized 9 language-related subcortical white matter pathways. By using 100% FAT, the mean percentage of visualized tracts was 13.5%, whereas DTI FT performed with 75%, 50%, and 25% FAT detected 30.6%, 61.3%, and 93.7% of language-related fiber tracts, respectively. COMPARISON WITH EXISTING METHODS nTMS language mapping alone is not able to visualize subcortical language-related pathways. CONCLUSIONS This study shows that nTMS language maps are feasible for DTI FT of language-related pathways within the scope of a FAT-based protocol. Although this approach is novel and might be helpful during scientific neuroimaging and tumor resection, intraoperative validation is needed to go beyond the level of feasibility.
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Affiliation(s)
- Nico Sollmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Chiara Negwer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Stefanie Maurer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Theresa Hauck
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Jan S Kirschke
- Section of Neuroradiology, Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
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Ahmad RF, Malik AS, Kamel N, Reza F, Abdullah JM. Simultaneous EEG-fMRI for working memory of the human brain. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:363-78. [PMID: 27043850 DOI: 10.1007/s13246-016-0438-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 03/14/2016] [Indexed: 02/06/2023]
Abstract
Memory plays an important role in human life. Memory can be divided into two categories, i.e., long term memory and short term memory (STM). STM or working memory (WM) stores information for a short span of time and it is used for information manipulations and fast response activities. WM is generally involved in the higher cognitive functions of the brain. Different studies have been carried out by researchers to understand the WM process. Most of these studies were based on neuroimaging modalities like fMRI, EEG, MEG etc., which use standalone processes. Each neuroimaging modality has some pros and cons. For example, EEG gives high temporal resolution but poor spatial resolution. On the other hand, the fMRI results have a high spatial resolution but poor temporal resolution. For a more in depth understanding and insight of what is happening inside the human brain during the WM process or during cognitive tasks, high spatial as well as high temporal resolution is desirable. Over the past decade, researchers have been working to combine different modalities to achieve a high spatial and temporal resolution at the same time. Developments of MRI compatible EEG equipment in recent times have enabled researchers to combine EEG-fMRI successfully. The research publications in simultaneous EEG-fMRI have been increasing tremendously. This review is focused on the WM research involving simultaneous EEG-fMRI data acquisition and analysis. We have covered the simultaneous EEG-fMRI application in WM and data processing. Also, it adds to potential fusion methods which can be used for simultaneous EEG-fMRI for WM and cognitive tasks.
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Affiliation(s)
- Rana Fayyaz Ahmad
- Centre for Intelligent Signal and Imaging Research (CISIR), Tronoh, Malaysia. .,Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, 32610, Bandar Seri Iskandar, Perak, Malaysia.
| | - Aamir Saeed Malik
- Centre for Intelligent Signal and Imaging Research (CISIR), Tronoh, Malaysia. .,Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, 32610, Bandar Seri Iskandar, Perak, Malaysia.
| | - Nidal Kamel
- Centre for Intelligent Signal and Imaging Research (CISIR), Tronoh, Malaysia.,Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, 32610, Bandar Seri Iskandar, Perak, Malaysia
| | - Faruque Reza
- Department of Neurosciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.,Centre for Neuroscience Services and Research, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.,Centre for Neuroscience Services and Research, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia
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Abstract
Functional magnetic resonance imaging (fMRI) maps the spatiotemporal distribution of neural activity in the brain under varying cognitive conditions. Since its inception in 1991, blood oxygen level-dependent (BOLD) fMRI has rapidly become a vital methodology in basic and applied neuroscience research. In the clinical realm, it has become an established tool for presurgical functional brain mapping. This chapter has three principal aims. First, we review key physiologic, biophysical, and methodologic principles that underlie BOLD fMRI, regardless of its particular area of application. These principles inform a nuanced interpretation of the BOLD fMRI signal, along with its neurophysiologic significance and pitfalls. Second, we illustrate the clinical application of task-based fMRI to presurgical motor, language, and memory mapping in patients with lesions near eloquent brain areas. Integration of BOLD fMRI and diffusion tensor white-matter tractography provides a road map for presurgical planning and intraoperative navigation that helps to maximize the extent of lesion resection while minimizing the risk of postoperative neurologic deficits. Finally, we highlight several basic principles of resting-state fMRI and its emerging translational clinical applications. Resting-state fMRI represents an important paradigm shift, focusing attention on functional connectivity within intrinsic cognitive networks.
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Affiliation(s)
- Bradley R Buchbinder
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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BIL&GIN: A neuroimaging, cognitive, behavioral, and genetic database for the study of human brain lateralization. Neuroimage 2016; 124:1225-1231. [DOI: 10.1016/j.neuroimage.2015.02.071] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 02/16/2015] [Accepted: 02/25/2015] [Indexed: 11/22/2022] Open
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Wang D, Buckner RL, Fox MD, Holt DJ, Holmes AJ, Stoecklein S, Langs G, Pan R, Qian T, Li K, Baker JT, Stufflebeam SM, Wang K, Wang X, Hong B, Liu H. Parcellating cortical functional networks in individuals. Nat Neurosci 2015; 18:1853-60. [PMID: 26551545 PMCID: PMC4661084 DOI: 10.1038/nn.4164] [Citation(s) in RCA: 323] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/14/2015] [Indexed: 12/19/2022]
Abstract
The capacity to identify the unique functional architecture of an individual's brain is a crucial step toward personalized medicine and understanding the neural basis of variation in human cognition and behavior. Here we developed a cortical parcellation approach to accurately map functional organization at the individual level using resting-state functional magnetic resonance imaging (fMRI). A population-based functional atlas and a map of inter-individual variability were employed to guide the iterative search for functional networks in individual subjects. Functional networks mapped by this approach were highly reproducible within subjects and effectively captured the variability across subjects, including individual differences in brain lateralization. The algorithm performed well across different subject populations and data types, including task fMRI data. The approach was then validated by invasive cortical stimulation mapping in surgical patients, suggesting potential for use in clinical applications.
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Affiliation(s)
- Danhong Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Randy L. Buckner
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychology, Center for Brain Science, Harvard University, Cambridge, MA, USA
| | - Michael D. Fox
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daphne J. Holt
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Avram J. Holmes
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Sophia Stoecklein
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Ludwig Maximilians University Munich, Institute of Clinical Radiology, Munich, Germany
| | - Georg Langs
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
- Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ruiqi Pan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Tianyi Qian
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
- Siemens Healthcare, MR Collaboration NE Asia, Beijing, China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Justin T. Baker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA
| | - Steven M. Stufflebeam
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Harvard-MIT Health Sciences and Technology, Institute for Medical Engineering and Science, Cambridge, MA, USA
| | - Kai Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaomin Wang
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Bo Hong
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Hesheng Liu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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79
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Babajani-Feremi A, Narayana S, Rezaie R, Choudhri AF, Fulton SP, Boop FA, Wheless JW, Papanicolaou AC. Language mapping using high gamma electrocorticography, fMRI, and TMS versus electrocortical stimulation. Clin Neurophysiol 2015; 127:1822-36. [PMID: 26679420 DOI: 10.1016/j.clinph.2015.11.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/30/2015] [Accepted: 11/19/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the present study was to compare localization of the language cortex using cortical stimulation mapping (CSM), high gamma electrocorticography (hgECoG), functional magnetic resonance imaging (fMRI), and transcranial magnetic stimulation (TMS). METHODS Language mapping using CSM, hgECoG, fMRI, and TMS were compared in nine patients with epilepsy. Considering CSM as reference, we compared language mapping approaches based on hgECoG, fMRI, and TMS using their sensitivity, specificity, and the results of receiver operating characteristic (ROC) analyses. RESULTS Our results show that areas involved in language processing can be identified by hgECoG, fMRI, and TMS. The average sensitivity/specificity of hgECoG, fMRI, and TMS across all patients was 100%/85%, 50%/80%, and 67%/66%, respectively. The average area under the ROC curve of hgECoG, fMRI, and TMS across CSM-positive patients was 0.98, 0.76, and 0.68, respectively. CONCLUSIONS There is considerable concordance between CSM, hgECoG, fMRI, and TMS language mapping. Our results reveal that hgECoG, fMRI, and TMS are valuable tools for presurgical language mapping. SIGNIFICANCE Language mapping on the basis of hgECoG, fMRI, and TMS can provide important additional information, therefore, these methods can be used in conjunction with CSM or as an alternative, when the latter is deemed impractical.
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Affiliation(s)
- Abbas Babajani-Feremi
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Shalini Narayana
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Roozbeh Rezaie
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Asim F Choudhri
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephen P Fulton
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Frederick A Boop
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James W Wheless
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew C Papanicolaou
- Department of Pediatrics, Division of Clinical Neurosciences, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
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Desai AA, Strother MK, Faraco CC, Morgan VL, Ladner TR, Dethrage LM, Jordan LC, Donahue MJ. The Contribution of Common Surgically Implanted Hardware to Functional MR Imaging Artifacts. AJNR Am J Neuroradiol 2015; 36:2068-73. [PMID: 26272973 DOI: 10.3174/ajnr.a4419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/26/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Blood oxygenation level-dependent MR imaging is increasingly used clinically to noninvasively assess cerebrovascular reactivity and/or language and motor function. However, many patients have metallic implants, which will induce susceptibility artifacts, rendering the functional information uninformative. Here, we calculate and interpret blood oxygenation level-dependent MR imaging artifact impact arising from surgically implanted hardware. MATERIALS AND METHODS A retrospective analysis of all blood oxygenation level-dependent MRIs (n = 343; B0 = 3T; TE = 35 ms; gradient echo EPI) acquired clinically (year range = 2006-2014) at our hospital was performed. Blood oxygenation level-dependent MRIs were most commonly prescribed for patients with cerebrovascular disease (n = 80) or patients undergoing language or motor localization (n = 263). Artifact volume (cubic centimeters) and its impact on clinical interpretation were determined by a board-certified neuroradiologist. RESULTS Mean artifact volume associated with intracranial hardware was 4.3 ± 3.2 cm(3) (range = 1.1-9.4 cm(3)). The mean artifact volume from extracranial hardware in patients with cerebrovascular disease was 28.4 ± 14.0 cm(3) (range = 6.1-61.7 cm(3)), and in patients with noncerebrovascular disease undergoing visual or motor functional mapping, it was 39.9 (3)± 27.0 cm(3) (range = 6.9-77.1 cm(3)). The mean artifact volume for ventriculoperitoneal shunts was 95.7 ± 39.3 cm(3) (range = 64.0-139.6 cm(3)). Artifacts had no-to-mild effects on clinical interpretability in all patients with intracranial implants. Extracranial hardware artifacts had no-to-moderate impact on clinical interpretability, with the exception of 1 patient with 12 KLS-Martin maxDrive screws with severe artifacts precluding clinical interpretation. All examined ventriculoperitoneal shunts resulted in moderate-to-severe artifacts, limiting clinical interpretation. CONCLUSIONS Blood oxygenation level-dependent MR imaging yields interpretable functional maps in most patients beyond a small (30-40 cm(3)) artifact surrounding the hardware. Exceptions were ventriculoperitoneal shunts, particularly those with programmable valves and siphon gauges, and large numbers of KLS-Martin maxDrive screws.
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Affiliation(s)
- A A Desai
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.)
| | - M K Strother
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.)
| | - C C Faraco
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.)
| | - V L Morgan
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.)
| | - T R Ladner
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.)
| | - L M Dethrage
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.)
| | | | - M J Donahue
- From the Departments of Radiology and Radiological Sciences (A.A.D., M.K.S., C.C.F., V.L.M., T.R.L., L.M.D., M.J.D.) Division of Pediatric Neurology, Psychiatry (M.J.D.) Neurology (M.J.D.), Vanderbilt University School of Medicine, Nashville, Tennessee Department of Physics and Astronomy (M.J.D.), Vanderbilt University, Nashville, Tennessee
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81
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Mankinen K, Ipatti P, Harila M, Nikkinen J, Paakki JJ, Rytky S, Starck T, Remes J, Tokariev M, Carlson S, Tervonen O, Rantala H, Kiviniemi V. Reading, listening and memory-related brain activity in children with early-stage temporal lobe epilepsy of unknown cause-an fMRI study. Eur J Paediatr Neurol 2015; 19:561-71. [PMID: 26026490 DOI: 10.1016/j.ejpn.2015.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/25/2015] [Accepted: 05/05/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The changes in functional brain organization associated with paediatric epilepsy are largely unknown. Since children with epilepsy are at risk of developing learning difficulties even before or shortly after the onset of epilepsy, we assessed the functional organization of memory and language in paediatric patients with temporal lobe epilepsy (TLE) at an early stage in epilepsy. METHODS Functional magnetic resonance imaging was used to measure the blood oxygenation level-dependent (BOLD) response to four cognitive tasks measuring reading, story listening, memory encoding and retrieval in a population-based group of children with TLE of unknown cause (n = 21) and of normal intelligence and a healthy age and gender-matched control group (n = 21). RESULTS Significant BOLD response differences were found only in one of the four tasks. In the story listening task, significant differences were found in the right hemispheric temporal structures, thalamus and basal ganglia. Both activation and deactivation differed significantly between the groups, activation being increased and deactivation decreased in the TLE group. Furthermore, the patients with abnormal electroencephalograms (EEGs) showed significantly increased activation bilaterally in the temporal structures, basal ganglia and thalamus relative to those with normal EEGs. The patients with normal interictal EEGs had a significantly stronger deactivation than those with abnormal EEGs or the controls, the differences being located outside the temporal structures. CONCLUSIONS Our results suggest that TLE entails a widespread disruption of brain networks. This needs to be taken into consideration when evaluating learning abilities in patients with TLE. The thalamus seems to play an active role in TLE. The changes in deactivation may reflect neuronal inhibition.
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Affiliation(s)
- Katariina Mankinen
- Department of Paediatrics, Oulu University Hospital, PB 29, 90014 Oulu, Finland.
| | - Pieta Ipatti
- Clinic of Diagnostic Radiology, Oulu University Hospital, Finland
| | - Marika Harila
- Department of Neurology, Oulu University Hospital, Finland
| | - Juha Nikkinen
- Clinic of Diagnostic Radiology, Oulu University Hospital, Finland
| | | | - Seppo Rytky
- Department of Clinical Neurophysiology, Oulu University Hospital, Finland
| | - Tuomo Starck
- Clinic of Diagnostic Radiology, Oulu University Hospital, Finland
| | - Jukka Remes
- Clinic of Diagnostic Radiology, Oulu University Hospital, Finland
| | - Maksym Tokariev
- Brain Research Unit, O.V. Lounasmaa Laboratory, Aalto University School of Science, P.B. 15100, 00076 Aalto, Finland; Neuroscience Unit, Institute of Biomedicine/Physiology, University of Helsinki, P.B. 63, 00014 University of Helsinki, Finland
| | - Synnöve Carlson
- Brain Research Unit, O.V. Lounasmaa Laboratory, Aalto University School of Science, P.B. 15100, 00076 Aalto, Finland; Neuroscience Unit, Institute of Biomedicine/Physiology, University of Helsinki, P.B. 63, 00014 University of Helsinki, Finland
| | - Osmo Tervonen
- Clinic of Diagnostic Radiology, Oulu University Hospital, Finland
| | - Heikki Rantala
- Department of Paediatrics, Oulu University Hospital, PB 29, 90014 Oulu, Finland
| | - Vesa Kiviniemi
- Clinic of Diagnostic Radiology, Oulu University Hospital, Finland
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Raslau FD, Mark LP, Sabsevitz DS, Ulmer JL. Imaging of Functional and Dysfunctional Episodic Memory. Semin Ultrasound CT MR 2015; 36:260-74. [PMID: 26233860 DOI: 10.1053/j.sult.2015.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A foundational framework for understanding functional and dysfunctional imaging of episodic memory emerges from the last 3 decades of human and animal research. This comprehensive review is presented from the vantage point of the fornix, a white matter bridge that occupies a central position in this functional network. Salient insights are identified, spanning topics such as hippocampal efferent and afferent networks, input and processing streams, hemispheric specialization, dysfunctional effects of pathologic and surgical injury, optimization of functional magnetic resonance imaging design and neuropsychological tests, and rehabilitation strategies. Far-reaching implications are considered for radiologists, whose clinical effect stretches beyond imaging and interfaces with neurosurgeons, neuropsychologists, and other neurospecialists.
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Affiliation(s)
| | - Leighton P Mark
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - David S Sabsevitz
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - John L Ulmer
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
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Beimer NJ, Buchtel HA, Glynn SM. One center's experience with complications during the Wada test. Epilepsia 2015; 56:e110-3. [DOI: 10.1111/epi.13046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Nicholas J. Beimer
- Department of Neurology; University of Michigan; Ann Arbor Michigan U.S.A
| | - Henry A. Buchtel
- Department of Psychiatry; University of Michigan; Ann Arbor Michigan U.S.A
- Neuropsychology Section; VA Ann Arbor; Ann Arbor Michigan U.S.A
| | - Simon M. Glynn
- Department of Neurology; University of Michigan; Ann Arbor Michigan U.S.A
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Variation in homotopic areas' activity and inter-hemispheric intrinsic connectivity with type of language lateralization: an FMRI study of covert sentence generation in 297 healthy volunteers. Brain Struct Funct 2015; 221:2735-53. [PMID: 26013303 DOI: 10.1007/s00429-015-1068-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
We investigated the regional correlates of differences in hemispheric lateralization in 297 healthy volunteers [including 153 left-handers (LH)] previously classified into three types of language lateralization according to their hemispheric functional lateralization index measured with fMRI during covert sentence production versus word list production (PRODSENT-LIST): 250 leftward asymmetrical Typicals, 10 rightward asymmetrical Strong-atypicals (only LH), and 37 Ambilaterals with weak lateralization. Using a functionally driven homotopic atlas (AICHA), we compared patterns of regional asymmetry during PRODSENT-LIST in these three groups. Among the 192 homotopic regions of interest (hROIs) of the AICHA atlas, 58 exhibited a significant effect of the type of lateralization on their BOLD signal variation during PRODSENT-LIST. The analyses of patterns of asymmetry of these 58 hROIs showed that (1) hROIs asymmetries in Strong-atypicals were significantly negatively correlated with those observed in Typicals, which indicates that their regional pattern of rightward asymmetries was comparable to the regional pattern of leftward language asymmetries of Typicals; (2) right- and left-handed Typicals had identical profiles, whereas left-handed Ambilaterals exhibited reduced leftward asymmetry as compared either to right-handed Ambilaterals or to Typicals. Moreover, left-handed Ambilaterals pattern of hROIs asymmetries significantly positively correlated with those of both Typicals and Strong-atypicals. In 291 of the participants, we tested the hypothesis that differences in language lateralization were associated with differences in inter-hemispheric connectivity during resting state by measuring their regional homotopic inter-hemispheric intrinsic connectivity coefficient (rHIICC) in 36 of the 58 hROIs known to be connected via the corpus callosum. Mean rHIICCs were negatively correlated with task-induced functional asymmetries, suggesting that enhanced inter-hemispheric cooperation at rest translates into increased inter-hemispheric cooperation during language production. In addition, the left-handed Ambilaterals exhibited a significantly larger rHIICC compared with right-handed Ambilaterals and Typicals, confirming a difference in inter-hemispheric organization in this group.
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85
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Rathore C, Alexander A, Sarma PS, Radhakrishnan K. Memory outcome following left anterior temporal lobectomy in patients with a failed Wada test. Epilepsy Behav 2015; 44:207-12. [PMID: 25768711 DOI: 10.1016/j.yebeh.2015.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/09/2015] [Accepted: 02/09/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to compare the memory outcome following left anterior temporal lobectomy (ATL) between patients with a failed Wada test and patients who passed the Wada test. METHODS From 1996 to 2002, we performed the Wada test on all patients with unilateral left mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and concordant electroclinical data before ATL. We used a 12-item recognition paradigm for memory testing and awarded a score of +1 for each correct response and -0.5 for each incorrect response. No patient was denied surgery on the basis of Wada scores. We assessed cognitive and memory functions using the Wechsler Adult Intelligence Scale and the Wechsler Memory Scale preoperatively and at one year after ATL. We compared the number of patients who showed decline in memory scores, as per the published reliable change indices, between the patients with a failed Wada test and the patients who passed the Wada test. RESULTS Out of the 116 eligible patients with left MTLE-HS, 88 underwent bilateral Wada test, while 28 underwent ipsilateral Wada test. None of them developed postoperative amnesia. Approximately, one-third of patients with a failed Wada memory test when the failure was defined as a contralateral score of <4, as an ipsilateral score of >8, and as an asymmetry score of <0. The patients with Wada memory failure had a longer pre-ATL duration of epilepsy (p<0.003). The memory and quality-of-life outcomes did not differ between the group with a failed Wada memory test and the group who passed the Wada memory test. The results remained the same when analyses were repeated at various other cutoff points. CONCLUSION The patients with left MTLE-HS with concordant electroclinical, MRI, and neuropsychological data should not be denied ATL solely on the basis of Wada memory test results.
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Affiliation(s)
- Chaturbhuj Rathore
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Aley Alexander
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P Sankara Sarma
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Kurupath Radhakrishnan
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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Abstract
Advanced MR imaging techniques have found extensive utility in the clinical practice of neuroradiology. A variety of these techniques are incorporated into imaging protocols for routine use, specific applications to particular disease entities, or as problem-solving tools on an ad hoc basis. This article summarizes and illustrates the spectrum of advanced MR imaging tools used clinically in the practice of neuroradiology.
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Połczyńska MM, Benjamin CFA, Moseley BD, Walshaw P, Eliashiv D, Vigil C, Jones M, Bookheimer SY. Role of the Wada test and functional magnetic resonance imaging in preoperative mapping of language and memory: two atypical cases. Neurocase 2015; 21:707-20. [PMID: 25372664 DOI: 10.1080/13554794.2014.977300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The Wada test is an invasive procedure used to determine cerebral memory and language dominance as well as risk of cognitive deficits following neurosurgery. However, the potential risks of Wada testing have led some to consider foregoing Wada testing in candidates for resective epilepsy surgery with right hemispheric seizure onset. We present two atypical cases in which the Wada test showed unexpected memory and language lateralization. These cases underscore the importance of functional magnetic resonance in which imaging and Wada examination in right-handed individuals even when the lesion would not suggest atypical language representation.
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Affiliation(s)
- Monika M Połczyńska
- a Department of Psychiatry and Biobehavioral Sciences , University of California , Los Angeles , CA , USA
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Norrelgen F, Lilja A, Ingvar M, Åmark P, Fransson P. Presurgical language lateralization assessment by fMRI and dichotic listening of pediatric patients with intractable epilepsy. NEUROIMAGE-CLINICAL 2014; 7:230-9. [PMID: 25610785 PMCID: PMC4300009 DOI: 10.1016/j.nicl.2014.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/01/2014] [Accepted: 12/16/2014] [Indexed: 11/29/2022]
Abstract
Objective The aim of this study was to evaluate the clinical use of a method to assess hemispheric language dominance in pediatric candidates for epilepsy surgery. The method is designed for patients but has previously been evaluated with healthy children. Methods Nineteen patients, 8–18 years old, with intractable epilepsy and candidates for epilepsy surgery were assessed. The assessment consisted of two functional MRI protocols (fMRI) intended to target frontal and posterior language networks respectively, and a behavioral dichotic listening task (DL). Regional left/right indices for each fMRI task from the frontal, temporal and parietal lobe were calculated, and left/right indices of the DL task were calculated from responses of consonants and vowels, separately. A quantitative analysis of each patient's data set was done in two steps based on clearly specified criteria. First, fMRI data and DL data were analyzed separately to determine whether the result from each of these assessments were conclusive or not. Thereafter, the results from the individual assessments were combined to reach a final conclusion regarding hemispheric language dominance. Results For 14 of the 19 subjects (74%) a conclusion was reached about their hemispheric language dominance. Nine subjects had a left-sided and five subjects had a right-sided hemispheric dominance. In three cases (16%) DL provided critical data to reach a conclusive result. Conclusions The success rate of conclusive language lateralization assessments in this study is comparable to reported rates on similar challenged pediatric populations. The results are promising but data from more patients than in the present study will be required to conclude on the clinical applicability of the method. Language lateralization was assessed in 19 pediatric candidates for epilepsy surgery. The assessment involved fMRI and an independent behavioral measure; dichotic listening. A two step analysis was employed combining fMRI and dichotic listening data. For 74% of the subjects a conclusion was reached about hemispheric language dominance. The rate of conclusive assessments in this study is comparable to reported rates on similar challenged pediatric populations.
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Affiliation(s)
- Fritjof Norrelgen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ; Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Lilja
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per Åmark
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Peter Fransson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Mellet E, Zago L, Jobard G, Crivello F, Petit L, Joliot M, Mazoyer B, Tzourio-Mazoyer N. Weak language lateralization affects both verbal and spatial skills: An fMRI study in 297 subjects. Neuropsychologia 2014; 65:56-62. [DOI: 10.1016/j.neuropsychologia.2014.10.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 12/29/2022]
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Carey DP, Johnstone LT. Quantifying cerebral asymmetries for language in dextrals and adextrals with random-effects meta analysis. Front Psychol 2014; 5:1128. [PMID: 25408673 PMCID: PMC4219560 DOI: 10.3389/fpsyg.2014.01128] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 09/16/2014] [Indexed: 12/31/2022] Open
Abstract
Speech and language-related functions tend to depend on the left hemisphere more than the right in most right-handed (dextral) participants. This relationship is less clear in non-right handed (adextral) people, resulting in surprisingly polarized opinion on whether or not they are as lateralized as right handers. The present analysis investigates this issue by largely ignoring methodological differences between the different neuroscientific approaches to language lateralization, as well as discrepancies in how dextral and adextral participants were recruited or defined. Here we evaluate the tendency for dextrals to be more left hemisphere dominant than adextrals, using random effects meta analyses. In spite of several limitations, including sample size (in the adextrals in particular), missing details on proportions of groups who show directional effects in many experiments, and so on, the different paradigms all point to proportionally increased left hemispheric dominance in the dextrals. These results are analyzed in light of the theoretical importance of these subtle differences for understanding the cognitive neuroscience of language, as well as the unusual asymmetry in most adextrals.
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Affiliation(s)
- David P Carey
- Perception, Action and Memory Research Group, School of Psychology, Bangor University Bangor, UK
| | - Leah T Johnstone
- Perception, Action and Memory Research Group, School of Psychology, Bangor University Bangor, UK
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Contribution of research on 'Epilepsy & behavior' to the refinement of functional brain atlas in four dimensions. Epilepsy Behav 2014; 40:86-8. [PMID: 25262069 PMCID: PMC4254342 DOI: 10.1016/j.yebeh.2014.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 08/18/2014] [Indexed: 11/22/2022]
Abstract
Intracranial stimulation mapping by Penfield et al. largely contributed to our current knowledge of the functional organization of motor, sensory, and language systems. The functional maps were generated and printed in two dimensions, based on the summary results of direct cortical stimulation of which locations varied across patients. Intracranial measurement of electrocorticographic changes elicited by a task can localize the regions involved in or participating to the given task. Augmentation of high-gamma activity at >80 Hz is considered to reflect in situ cortical activation at each moment. In the late 2000s, the spatial-temporal profiles of event-related high-gamma activity began to be published as a video material in journals. We have referred to our animation movie as ‘in-vivo animation of event-related high-gamma activity’, that demonstrates ‘when’ and ‘where’ cortical regions are activated in a self-explanatory fashion. Summation of event-related high-gamma measures derived from a large cohort of patients, as previously performed by Penfield et al, is expected to generate unique four-dimensional functional brain atlas covering the whole cerebral cortex.
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92
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Mazoyer B, Zago L, Jobard G, Crivello F, Joliot M, Perchey G, Mellet E, Petit L, Tzourio-Mazoyer N. Gaussian mixture modeling of hemispheric lateralization for language in a large sample of healthy individuals balanced for handedness. PLoS One 2014; 9:e101165. [PMID: 24977417 PMCID: PMC4076312 DOI: 10.1371/journal.pone.0101165] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/03/2014] [Indexed: 12/22/2022] Open
Abstract
Hemispheric lateralization for language production and its relationships with manual preference and manual preference strength were studied in a sample of 297 subjects, including 153 left-handers (LH). A hemispheric functional lateralization index (HFLI) for language was derived from fMRI acquired during a covert sentence generation task as compared with a covert word list recitation. The multimodal HFLI distribution was optimally modeled using a mixture of 3 and 4 Gaussian functions in right-handers (RH) and LH, respectively. Gaussian function parameters helped to define 3 types of language hemispheric lateralization, namely "Typical" (left hemisphere dominance with clear positive HFLI values, 88% of RH, 78% of LH), "Ambilateral" (no dominant hemisphere with HFLI values close to 0, 12% of RH, 15% of LH) and "Strongly-atypical" (right-hemisphere dominance with clear negative HFLI values, 7% of LH). Concordance between dominant hemispheres for hand and for language did not exceed chance level, and most of the association between handedness and language lateralization was explained by the fact that all Strongly-atypical individuals were left-handed. Similarly, most of the relationship between language lateralization and manual preference strength was explained by the fact that Strongly-atypical individuals exhibited a strong preference for their left hand. These results indicate that concordance of hemispheric dominance for hand and for language occurs barely above the chance level, except in a group of rare individuals (less than 1% in the general population) who exhibit strong right hemisphere dominance for both language and their preferred hand. They call for a revisit of models hypothesizing common determinants for handedness and for language dominance.
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Affiliation(s)
- Bernard Mazoyer
- Groupe d’Imagerie Neurofonctionnelle, Centre National de la Recherche Scientifique, Commissariat à l’Energie Atomique, et Université de Bordeaux, Bordeaux, France
| | - Laure Zago
- Groupe d’Imagerie Neurofonctionnelle, Centre National de la Recherche Scientifique, Commissariat à l’Energie Atomique, et Université de Bordeaux, Bordeaux, France
| | - Gaël Jobard
- Groupe d’Imagerie Neurofonctionnelle, Centre National de la Recherche Scientifique, Commissariat à l’Energie Atomique, et Université de Bordeaux, Bordeaux, France
| | - Fabrice Crivello
- Groupe d’Imagerie Neurofonctionnelle, Centre National de la Recherche Scientifique, Commissariat à l’Energie Atomique, et Université de Bordeaux, Bordeaux, France
| | - Marc Joliot
- Groupe d’Imagerie Neurofonctionnelle, Centre National de la Recherche Scientifique, Commissariat à l’Energie Atomique, et Université de Bordeaux, Bordeaux, France
| | - Guy Perchey
- Groupe d’Imagerie Neurofonctionnelle, Centre National de la Recherche Scientifique, Commissariat à l’Energie Atomique, et Université de Bordeaux, Bordeaux, France
| | - Emmanuel Mellet
- Groupe d’Imagerie Neurofonctionnelle, Centre National de la Recherche Scientifique, Commissariat à l’Energie Atomique, et Université de Bordeaux, Bordeaux, France
| | - Laurent Petit
- Groupe d’Imagerie Neurofonctionnelle, Centre National de la Recherche Scientifique, Commissariat à l’Energie Atomique, et Université de Bordeaux, Bordeaux, France
| | - Nathalie Tzourio-Mazoyer
- Groupe d’Imagerie Neurofonctionnelle, Centre National de la Recherche Scientifique, Commissariat à l’Energie Atomique, et Université de Bordeaux, Bordeaux, France
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Miró J, Ripollés P, López-Barroso D, Vilà-Balló A, Juncadella M, de Diego-Balaguer R, Marco-Pallares J, Rodríguez-Fornells A, Falip M. Atypical language organization in temporal lobe epilepsy revealed by a passive semantic paradigm. BMC Neurol 2014; 14:98. [PMID: 24885511 PMCID: PMC4017227 DOI: 10.1186/1471-2377-14-98] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 03/17/2014] [Indexed: 11/12/2022] Open
Abstract
Background Mesial temporal lobe epilepsy (MTLE) is the most common type of focal epilepsy in adults and can be successfully cured by surgery. One of the main complications of this surgery however is a decline in language abilities. The magnitude of this decline is related to the degree of language lateralization to the left hemisphere. Most fMRI paradigms used to determine language dominance in epileptic populations have used active language tasks. Sometimes, these paradigms are too complex and may result in patient underperformance. Only a few studies have used purely passive tasks, such as listening to standard speech. Methods In the present study we characterized language lateralization in patients with MTLE using a rapid and passive semantic language task. We used functional magnetic resonance imaging (fMRI) to study 23 patients [12 with Left (LMTLE), 11 with Right mesial temporal lobe epilepsy (RMTLE)] and 19 healthy right-handed controls using a 6 minute long semantic task in which subjects passively listened to groups of sentences (SEN) and pseudo sentences (PSEN). A lateralization index (LI) was computed using a priori regions of interest of the temporal lobe. Results The LI for the significant contrasts produced activations for all participants in both temporal lobes. 81.8% of RMTLE patients and 79% of healthy individuals had a bilateral language representation for this particular task. However, 50% of LMTLE patients presented an atypical right hemispheric dominance in the LI. More importantly, the degree of right lateralization in LMTLE patients was correlated with the age of epilepsy onset. Conclusions The simple, rapid, non-collaboration dependent, passive task described in this study, produces a robust activation in the temporal lobe in both patients and controls and is capable of illustrating a pattern of atypical language organization for LMTLE patients. Furthermore, we observed that the atypical right-lateralization patterns in LMTLE patients was associated to earlier age at epilepsy onset. These results are in line with the idea that early onset of epileptic activity is associated to larger neuroplastic changes.
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Affiliation(s)
- Júlia Miró
- Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute]- IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain.
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Bauer PR, Reitsma JB, Houweling BM, Ferrier CH, Ramsey NF. Can fMRI safely replace the Wada test for preoperative assessment of language lateralisation? A meta-analysis and systematic review. J Neurol Neurosurg Psychiatry 2014; 85:581-8. [PMID: 23986313 DOI: 10.1136/jnnp-2013-305659] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Recent studies have shown that fMRI (functional magnetic resonance imaging) may be of value for pre-surgical assessment of language lateralisation. The aim of this study was to systematically review and analyse the available literature. A systematic electronic search for studies comparing fMRI with Wada testing was conducted in the PubMed database between March 2009 and November 2011. Studies involving unilateral Wada testing, study population consisting exclusively of children younger than 12 years of age or involving five patients or fewer were excluded. 22 studies (504 patients) were included. A random effects meta-analysis was conducted to obtain pooled estimates of the positive and negative predictive values of the fMRI using the Wada test as the reference standard. The impact of several study features on the performance of fMRI was assessed. The results showed that 81% of patients were correctly classified as having left or right language dominance or mixed language representation. Techniques were discordant in 19% of patients. fMRI and Wada test agreed in 94% for typical language lateralisation and in 51% for atypical language lateralisation. Language production or language comprehension tasks and different regions of interest did not yield statistically significant different results. It can be concluded that fMRI is reliable when there is strong left-lateralised language. The Wada test is warranted when fMRI fails to show clear left-lateralisation.
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Affiliation(s)
- Prisca R Bauer
- Department of Neurology and Neurosurgery, Section Brainfunction and Plasticity, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, , Utrecht, The Netherlands
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Comparison of high gamma electrocorticography and fMRI with electrocortical stimulation for localization of somatosensory and language cortex. Clin Neurophysiol 2014; 126:121-30. [PMID: 24845600 DOI: 10.1016/j.clinph.2014.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/17/2014] [Accepted: 04/16/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We investigated the contribution of electrocortical stimulation (ECS), induced high gamma electrocorticography (hgECoG) and functional magnetic resonance imaging (fMRI) for the localization of somatosensory and language cortex. METHODS 23 Epileptic patients with subdural electrodes underwent a protocol of somatosensory stimulation and/or an auditory semantic decision task. 14 Patients did the same protocol with fMRI prior to implantation. RESULTS ECS resulted in the identification of thumb somatosensory cortex in 12/16 patients. Taking ECS as a gold standard, hgECoG and fMRI identified 53.6/33% of true positive and 4/12% of false positive contacts, respectively. The hgECoG false positive sites were all found in the hand area of the post-central gyrus. ECS localized language-related sites in 7/12 patients with hgECoG and fMRI showing 50/64% of true positive and 8/23% of false positive contacts, respectively. All but one of the hgECoG/fMRI false positive contacts were located in plausible language areas. Four patients showed post-surgical impairments: the resection included the sites positively indicated by ECS, hgECoG and fMRI in 3 patients and a positive hgECoG site in one patient. CONCLUSIONS HgECoG and fMRI provide additional localization information in patients who cannot sufficiently collaborate during ECS. SIGNIFICANCE HgECoG and fMRI make the cortical mapping procedure more flexible not only by identifying priority cortical sites for ECS or when ECS is not feasible, but also when ECS does not provide any result.
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Heschl’s gyrification pattern is related to speech-listening hemispheric lateralization: FMRI investigation in 281 healthy volunteers. Brain Struct Funct 2014; 220:1585-99. [PMID: 24638878 DOI: 10.1007/s00429-014-0746-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 02/28/2014] [Indexed: 11/27/2022]
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Barnett A, Marty-Dugas J, McAndrews MP. Advantages of sentence-level fMRI language tasks in presurgical language mapping for temporal lobe epilepsy. Epilepsy Behav 2014; 32:114-20. [PMID: 24534479 DOI: 10.1016/j.yebeh.2014.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 01/18/2014] [Accepted: 01/20/2014] [Indexed: 01/22/2023]
Abstract
fMRI language mapping has become increasingly utilized for determining language dominance before surgical intervention for temporal lobe epilepsy (TLE). This study aimed to examine the differences between two classes of fMRI word generation tasks used in our clinic: tasks using a single word cue, referred to as simple generative tasks (SGTs), and tasks also involving sentence-level processing, referred to as sentence-level language tasks (SLTs). Specifically, we aimed to investigate the extent and laterality of activation and frontal-temporal connectivity during these language tasks and their relationship to clinical language measures. Thirty-one patients with TLE (18 patients with left TLE and 13 patients with right TLE) performed four language tasks during an fMRI scan, two SGTs and two SLTs. We found significantly greater activity for SLTs over SGTs in bilateral inferior frontal and middle temporal gyri and the left temporal pole. Sentence-level language tasks also showed greater lateralization compared with SGTs. Finally, we found that while activation extent did not correlate with clinical language tests, the degree of left frontal-temporal connectivity was significantly correlated with naming and semantic fluency performance. These correlations also were more robust for SLTs than for SGTs. Taken together, these results provide a compelling argument for including some form of SLTs in fMRI language lateralization protocols for TLE as they allow for better characterization of language networks, particularly in the temporal lobes which are at risk in surgery.
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Affiliation(s)
- Alexander Barnett
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Krembil Neuroscience Centre & Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada.
| | - Jeremy Marty-Dugas
- Krembil Neuroscience Centre & Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Mary Pat McAndrews
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Krembil Neuroscience Centre & Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
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Abstract
High-resolution magnetic resonance imaging (MRI) is invaluable for identifying cerebral tumors that cause epilepsy. Serial voxel-based automated quantitative analyses are more sensitive than visual reading for detecting change in a lesion. Eloquent cortex can be identified with functional MRI (fMRI), with cautions about the precise location and extent of critical cortex. Tractography is useful for delineating critical white matter tracks as are MR venography and computerized tomography (CT) angiography for displaying veins and arteries. These data may be combined into a three-dimensional (3D) multimodal MR data presentation and displayed interoperatively to increase the precision and minimize the risk of neurosurgical treatment, and for the illustrations.
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Affiliation(s)
- John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom
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Englot DJ, Chang EF. Rates and predictors of seizure freedom in resective epilepsy surgery: an update. Neurosurg Rev 2014; 37:389-404; discussion 404-5. [PMID: 24497269 DOI: 10.1007/s10143-014-0527-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 10/26/2013] [Accepted: 10/27/2013] [Indexed: 12/26/2022]
Abstract
Epilepsy is a debilitating neurological disorder affecting approximately 1 % of the world's population. Drug-resistant focal epilepsies are potentially surgically remediable. Although epilepsy surgery is dramatically underutilized among medically refractory patients, there is an expanding collection of evidence supporting its efficacy which may soon compel a paradigm shift. Of note is that a recent randomized controlled trial demonstrated that early resection leads to considerably better seizure outcomes than continued medical therapy in patients with pharmacoresistant temporal lobe epilepsy. In the present review, we provide a timely update of seizure freedom rates and predictors in resective epilepsy surgery, organized by the distinct pathological entities most commonly observed. Class I evidence, meta-analyses, and individual observational case series are considered, including the experiences of both our institution and others. Overall, resective epilepsy surgery leads to seizure freedom in approximately two thirds of patients with intractable temporal lobe epilepsy and about one half of individuals with focal neocortical epilepsy, although only the former observation is supported by class I evidence. Two common modifiable predictors of postoperative seizure freedom are early operative intervention and, in the case of a discrete lesion, gross total resection. Evidence-based practice guidelines recommend that epilepsy patients who continue to have seizures after trialing two or more medication regimens should be referred to a comprehensive epilepsy center for multidisciplinary evaluation, including surgical consideration.
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Affiliation(s)
- Dario J Englot
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, CA, USA,
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Curot J, Denuelle M, Busigny T, Barragan-Jason G, Kany M, Tall P, Marlat F, Fabre N, Valton L. Bilateral Wada test: Amobarbital or propofol? Seizure 2014; 23:122-8. [DOI: 10.1016/j.seizure.2013.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 10/18/2013] [Accepted: 10/20/2013] [Indexed: 11/17/2022] Open
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